Medical images are an important component of the medical record generated during a patient's hospital stay or clinic visit. The NIH Clinical Center (CC), like most university and research hospitals, is attempting to solve the problem of consolidating medical images with the conventional alphanumeric medical record data in the Medical Information System (MIS) to more completely realize the goal of a comprehensive electronic medical record. DCRT, CC, and NCI are collaborating to develop a series of demonstration projects that explore image integration into the electronic medical record. Chest X-rays are routinely obtained within the Diagnostic Radiology Department. In this application, we have been using a Vision Ten Rita! System, which contains a gray-scale sheet film digitizer as an integral par of an image gateway. Communication of medical images between the Radiology Department's film library and remote sites is now possible. In addition, we have implemented a prototype high-speed image communication network based on Asynchronous Transfer Mode (ATM) Switch technology. The ATM Switch allows 155 Mbit/sec multi-media communications between users. This prototype network will initially support high-performance radiation therapy planning, which is a collaborative effort between DCRT's Computational Bioscience and Engineering Laboratory (CBEL) and the NCI Radiation Oncology Branch. CBEL's IBM SP2 Supercomputer will be utilized t apply the power of parallel computing methods to the implementation of the computationally-intensive calculations required for radiation therapy planning. A custom-designed Radiology Consultation WorkStation (RCWS) is currently being developed for use in the NCI Radiation Oncology Branch, the CC Diagnostic Radiology Department, and the DCRT environment. The RCWS allows real-time telemedicine and multimedia conferencing between distributed sites. A shared-cursor feature allows each participant to see the regions outlined by the others. The prototype ATM network is connected to the DARPA-funded Advanced Technology Development Network (ATDNet). This ATDNet link will allow collaboration between the NIH and local sites, such as the Walter Reed Army Medical Center and the National Naval Medical Center. Future plans include teleconferencing with the Washington University in St. Louis via the NASA- sponsored ACTS Satellite.